On arrival, younger patients had significantly higher heart rates and more severe derangements in lactate levels, base deficits, and pH compared with older patients. There were no differences among age groups in injury severity score, systolic blood pressure, or mortality. CONCLUSIONS In massively transfused patients, mortality increased with age. However, a significant proportion of older adults were successfully resuscitated. Therefore, age alone should not be considered a contraindication to high-volume transfusion. Traditional physiologic and laboratory criteria indicative of hemorrhagic shock may have reduced reliability with increasing age, and thus providers must have a heightened suspicion for hemorrhage in the elderly. Early transfusion requirements can be combined with age to establish prognosis to define futility to help counsel families regarding mortality after traumatic injury. https://www.selleckchem.com/products/Sodium-valproate.html BACKGROUND Controversy exists over the timing of cholecystectomy for biliary pancreatitis in children. Some surgeons await normalization of serum lipase levels while others are guided by resolution of abdominal pain; however, there are minimal data to support either practice. We hypothesized that resolution of abdominal pain is equivalent in outcome to awaiting normalization of lipase levels in patients undergoing cholecystectomy for biliary pancreatitis. METHODS After institutional review board (IRB) approval, the medical record was retrospectively queried for all cases of cholecystectomy for biliary pancreatitis at our institution from 2007 to 2017. Patients undergoing chemotherapy, admitted for another cause, or who had severe underlying comorbidities like ventilator dependence were excluded. Patients were stratified into two cohorts those managed preoperatively by normalization of serum lipase levels versus resolution of abdominal pain. Demographics, serum lipase levels, postoperative complications, cost ontrended patients (11.5&nbsp;±&nbsp;8.1 versus 4.2&nbsp;±&nbsp;2.3&nbsp;d, P&nbsp; less then &nbsp;0.0001) and had a higher total cost of stay ($38,094&nbsp;±&nbsp;25,910 versus $20,205&nbsp;±&nbsp;5918, P&nbsp;=&nbsp;0.0007). CONCLUSIONS Our data suggest that in children with biliary pancreatitis, proceeding with cholecystectomy after resolution of abdominal pain is equivalent in outcomes to trending serum lipase levels but is more cost-effective with a decreased length of stay and decreased need for preoperative total parenteral nutrition. BACKGROUND Deep vein thromboses (DVTs) are a significant sequela of surgery and are associated with significant of morbidity and mortality in the United States. Operative emergency general surgery (EGS) cases have been demonstrated to have a greater burden of DVT than other types of surgery. MATERIALS AND METHODS DVT in EGS cases were identified from the National Inpatient Sample-Healthcare Cost and Utilization Project database from 2001 to 2015 Q3 based on ICD-9 code specification. National incidence of DVT in EGS was calculated using the National Inpatient Sample-Healthcare Cost and Utilization Project sampling methodology, and propensity score matching was used to assess costs associated with DVT. RESULTS Among 15,148,352 sample-weighted hospitalizations, 0.623% (94,392) experienced DVT. Incidence of DVT was greatest in GI ulcer surgery (1.705%) and lowest in appendectomy (0.095%). Patients with a perioperative DVT incurred $22,301 more in hospital-related costs than their counterparts who did not have a DVT. Although rates of DVT remained stable over the period analyzed, DVT-associated costs increased at a 2.09% annual rate in excess of inflation during the period analyzed. This increase in costs was most significant for laparotomy, which increased at a rate of 8.09% annually. CONCLUSIONS DVT continues to be a significant burden on resources in EGS in spite of efforts with DVT prophylaxis. Considering the increase in costs and little change in incidence, further research on cost-effective management of DVT in EGS is warranted. BACKGROUND Proximal (duodenal) small bowel adenocarcinomas have a worse prognosis than distal (jejuno-ileal) tumors, but differences in patient, tumor, and treatment factors between locations remain unclear. METHODS Patients in the National Cancer Database with surgically resected pathologic stage I-IV small bowel adenocarcinomas between 2004 and 2015 were analyzed. Clinical stage IV patients were excluded. RESULTS Proximal tumors (n&nbsp;=&nbsp;3767) were more likely to be higher grade (OR 1.52, CI 1.22-1.85 for moderately; OR 1.83, CI 1.49-2.33 for poorly differentiated, P&nbsp;&nbsp;5&nbsp;cm, P&nbsp; less then &nbsp;0.01). Proximal tumors were associated with worse overall survival (OS) and stage-specific survival compared with distal tumors (all P&nbsp; less then &nbsp;0.01). Cox regression analysis of the entire cohort showed worse survival with community versus academic cancer programs, higher comorbidity scores, pathologic stage IV, poorly differentiated histology, positive nodal or margin status, and proximal location, while female gender, larger tumor size, and chemotherapy predicted better survival. On separate Cox regression analyses of each location, neoadjuvant chemotherapy was associated with better OS in the proximal cohort (HR 0.70, CI 0.55-0.88, P&nbsp; less then &nbsp;0.01), while adjuvant chemotherapy was associated with better OS for both proximal (HR 0.49, CI 0.42-0.57, P&nbsp; less then &nbsp;0.01) and distal tumors (HR 0.68, CI 0.57-0.81, P&nbsp; less then &nbsp;0.01). CONCLUSIONS Proximal small bowel adenocarcinomas are associated with worse overall and stage-specific survival. This may be due to tumor biologic differences as proximal tumors were more likely to have higher grade. Future studies should further investigate differences between proximal and distal tumors to guide targeted treatment algorithms. BACKGROUND The American College of Surgeons (ACS) publishes Resources for Optimal Care of the Injured Patient (Orange Book) to provide common requirements to verify trauma centers (TCs), throughout the United States. There are very few studies that assess the impact of geography on TC outcomes. Our study aimed to evaluate the differences in geographic regions in terms of injury-adjusted all-cause mortality at ACS Level 1, 2, and 3&nbsp;TCs. METHODS Review of the 2016 Research Data Set provided by the National Trauma Data Bank. TCs were categorized by the Research Data Set into geographic regions Northeast, Midwest, South, and West. TCs were subcategorized into ACS Level 1, 2, or 3; all others were excluded. Injury-adjusted mortality was determined using observed/expected mortality (O/E) ratios, derived from TRISS methodology. Chi-squared and t-test analyses were used with significance defined as P-value less then 0.05. RESULTS Among Level 1&nbsp;TCs, the West (O/E&nbsp;=&nbsp;0.62) and South (0.61) regions had significantly higher adjusted mortality rates than the Level 1s in the Midwest (0.